Validation of Three Platelet Function Tests for Bleeding Risk Stratification During Dual Antiplatelet Therapy Following Coronary Interventions. Issue 7 (29th June 2016)

• Record Type: Journal Article
• Authors: Kim, Moo Hyun; Choi, Sun Young; An, Soo Yeon; Serebruany, Victor
• Is Part Of: Clinical cardiology. Volume 39:Issue 7(2016)
• Page Start: 385
• Page End: 390
• Publication Date: 2016-06-29
• Subjects: Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.22540
• Languages: English
• ISSNs: 0160-9289

Abstract

ABSTRACT: Background: Although low platelet reactivity (LPR) is commonly detected during bleeding, a validated threshold for reliable DAPT bleeding risk stratification is lacking. We tested the diagnostic utility of 3 conventional platelet‐activity assays to define the predictive value (if any) of LPR for bleeding. Hypothesis: We hypothesized whether one of these tests be better than any others for predicting bleeding events. Methods: Patients (n = 800) following drug‐eluting stent implantation received DAPT. Bleeding was assessed by Bleeding Academic Research Consortium (BARC) classification and events were collected for 1 year after stenting. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow, and multiple electrode aggregometry (MEA). The LPR values for bleeding event stratification were defined as ≤15% for LTA, ≤139 PRU for VerifyNow, and ≤25 U for MEA. Results: Bleeding events occurred in 18 patients (2.3%). All tests distinguished LPR as an independent predictor for bleeding by univariate analysis ([HR]: 5.00, 95% [CI]: 1.8‐14.0, P = 0.002 for LTA; HR: 21.3, 95% CI: 6.2‐73.0, P < 0.0001 for VerifyNow; and HR: 7.4, 95% CI: 2.2‐25.5, P = 0.002 for MEA). Multivariate analysis revealed that only VerifyNow (HR: 11.5, 95% CI: 2.9‐45.7, P < 0.0004) remained an independent predictor for bleeding. However, the specificity (81.5%, 60.2%, and 81.7%, respectively) and sensitivity (61.1%, 83.3%, and 83.2%, respectively) of all 3 tests were quite low. Conclusions: Among 3 conventional platelet‐activity assays, VerifyNow was better than LTA or MEA for triaging future bleeding risks. However, all 3 tests failed to reliably predict future bleeding.